Md. Code Regs. 10.09.51.01

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.51.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Audiologist" means a professional who is licensed in accordance with Regulation .02 of this chapter who treats hearing disorders and communication problems.

(2) "Audiology assessment" means procedures performed by an audiologist to evaluate and monitor the status of the peripheral auditory system, auditory nerve, and central auditory system, or to establish the site of the auditory disorder by using procedures to quantify and qualify hearing loss by site of lesion, on the basis of perceptual, physiological, or electrophysiological responses to acoustic stimuli, and to describe any communicative disorders.

(3) Audiology Center.

(a) 'Audiology center" means a multispecialty setting with all necessary equipment for audiology services that operates for the purpose of providing preventive, diagnostic, therapeutic, and rehabilitative audiology services, and other multispecialty services by or under the direction of a licensed physician or audiologist.

(b) "Audiology center" does not include the office of one or more private audiologists.

(4) "Audiology services" means services delivered by an audiologist to eligible participants in order to diagnose and treat hearing problems.

(5) "Auditory osseointegrated device" means a device implanted in the skull that replaces the function of the middle ear and provides mechanical energy to the cochlea via a mechanical transducer.

(6) "Bilateral" means relating to or involving both ears.

(7) "Cochlear implant" means a device that is implanted under the skin that picks up sounds and converts them to impulses transmitted to electrodes placed in the cochlea, restoring some hearing to people with a hearing impairment.

(8) "Department" means the Maryland Department of Health, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C § 1396 et seq.

(9) "Designee " means any entity designated to act on behalf of the Department.

(10) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)" means the provision of preventive health care under 42 CFR § 441.50 et seq., including medical and dental services, in order to assess growth and development and to detect and treat health problems in Medical Assistance eligible individuals under 21 years old.

(11) "EPSDT screening provider" means a physician, audiologist, or an authorized practitioner under Health Occupations Article, Annotated Code of Maryland.

(12) "Hearing aid" means an instrument or device that is designed for improving or correcting impaired human hearing, or any part or accessory of the instrument or device.

(13) "Hearing aid dispenser" means a person who is licensed in accordance with Regulation .02 of this chapter to sell hearing aids or provide other hearing aid services.

(14) "Hearing aid evaluation" means services provided to a participant by an audiologist for determining the benefit of hearing aids and, upon the audiologist's recommendation, the dispensing of hearing aids.

(15) "Maryland Medical Assistance Program(Program)" means the program of comprehensive medical and other health-related care for indigent and medically indigent individuals.

(16) "Medically necessary" means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with currently accepted standards of good medical practice;

(c) The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the consumer, family, or provider.

(17) "Participant" means an individual who is enrolled with the Department to receive Medical Assistance services.

(18) "Program" has the meaning stated in COMAR 10.09.36.01.

(19) "Provider" means an audiologist, audiology center, or hearing aid dispenser that is licensed and that, through an agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

(20) "Unilateral" means relating to, involving, or affecting one ear.

Md. Code Regs. 10.09.51.01

Regulation .01B amended effective July 18, 2005 (32:14 Md. R. 1275); January 16, 2006 (33:1 Md. R. 36); amended effective 45:21 Md. R. 973, eff. 10/8/2018; amended effective 45:21 Md. R. 973, eff. 10/22/2018